Primary care
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Headache is the most common neurologic complaint. Migraine is by far the most frequent headache type seen by office-based physicians. ⋯ With time severely restricted in primary care day-to-day practice, a user friendly approach to assessment of headaches and differentiation into the broad types of "worrisome headache," migraine, tension-type, and others is necessary. A consensus-based, practical, rapid, six essential-question screening technique is outlined.
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Headache research has been a productive area, and understanding of primary headache pathophysiology has increased greatly. There are many more questions that need to be answered to gain a better understanding of the primary headache process. For the clinician,there is value in understanding the pathophysiology of primary headache, because this understanding can help improve diagnostic acumen and shape treatment plans to provide patients with more effective treatment.
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Medication overuse headache may complicate any type of headache and occurs in young people, adults, and even elderly patients. Overuse of acute medications may change intermittent or self-limited headaches into chronic daily headache. ⋯ Prophylactic therapies are often ineffective in the setting of medication overuse. Recognition of this condition allows appropriate clinical intervention that includes cessation of the offending medications.
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The vast majority of patients presenting to primary care physicians complaining of headache have primary headaches, such as migraine,tension, or cluster. Secondary or organic headaches, however,always need to be considered, because when present they require prompt diagnosis and intervention. Approximately 10%of patients presenting to the emergency department complaining of headache have a secondary headache, and as many as one in three sudden severe headaches in patients presenting to a general practitioner's office can be attributed to an urgent neurologic condition that requires rapid evaluation and management.
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Women have more migraine than men. Some secondary headaches are more common in women. Menses, pregnancy, and menopause have an impact on the frequency and treatment of headache. Oral contraceptives can be used in women with migraine with some precautions.